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PubMed2005

A prospective study of posttraumatic stress and depressive reactions among treated and untreated adolescents 5 years after a catastrophic disaster.

OBJECTIVE: This study evaluated 1) the natural course of posttraumatic stress and depressive reactions among untreated adolescents from two cities in an earthquake zone (Gumri and Spitak) and one at the periphery (Yerevan) who were differentially exposed to the 1988 Spitak earthquake in Armenia and 2) the effectiveness of brief trauma/grief-focused psychotherapy among adolescents from Gumri. METHOD: One hundred twenty-five adolescents were assessed with the Child Posttraumatic Stress Disorder Reaction Index (CPTSD-RI) and the Depression Self-Rating Scale (DSRS) at 1.5 and 5 years postearthquake. At 1.5 years, trauma/grief-focused group and individual psychotherapy was provided over 6 weeks to a group of students in Gumri. RESULTS: CPTSD-RI scores among untreated adolescents from Gumri and Spitak subsided significantly but mildly at follow-up, with scores from Spitak, the city at the epicenter, remaining above the cutoff for a diagnosis of PTSD. DSRS scores increased mildly in both earthquake cities but only significantly in Gumri. Among treated adolescents in Gumri, improvement in CPTSD-RI scores was three times that of the untreated Gumri comparison group. The treated group also tended to improve on their DSRS scores, whereas these scores worsened significantly among untreated subjects. CONCLUSIONS: Untreated adolescents exposed to severe trauma are at risk for chronic PTSD and depressive symptoms. Brief trauma/grief-focused psychotherapy is effective in reducing PTSD symptoms and halting the progression of depression. This study supports the implementation of mental health intervention programs in schools after disasters to reduce trauma-related psychopathology.

Adolescent↗
PubMed1988

A preschooler in a disaster.

A search of the literature of children in disasters showed no case of individual therapy with such a child. The absence may be related to a specific countertransference. In the case of the preschooler presented here, the child's particular situation and developmental stage were significant aspects of his reaction and therapy.

Abreaction↗
PubMed1996

Symptoms of stress disorder and depression among trauma counselors after an airline disaster.

Psychological symptoms of 21 therapists who provided counseling to individuals affected by the crash of a commercial airliner were compared with those of 20 therapists from the same mental health center who did not participate in the disaster relief efforts. A symptoms checklist instrument was completed by both groups at four, eight, and 12 weeks after the crash. At four and eight weeks, the trauma counselors experienced significantly more symptoms of posttraumatic stress disorder and depression than the therapists in the control group. At 12 weeks the only significantly increased symptom among the trauma counselors was avoidance behavior.

Accidents, Aviation↗
PubMed1991

GC-NPD and GC-MS analysis of preserved tissue of Bhopal gas disaster: evidence of methyl carbamylation in post-mortem blood.

Twenty-five preserved autopsy blood samples of Bhopal toxic gas exposed victims were analysed by gas chromatography (GC) coupled with either Nitrogen-Phosphorous detector (NPD) or mass spectrometer (MS) for the presence of methyl carbamyl valine in terms of valine methyl hydantoin (VMH). 84% of these samples showed a positive test for VMH on GC-NPD and the identity of the peaks were further confirmed on GC-MS. The concentration of VMH in the gas-affected positive blood samples ranged from 2.56 to 51.28 nanomoles. These results indicate entry of methyl isocyanate (MIC), one of the constituents of the toxic cloud caused by the disaster, into the blood stream of victims who had inhaled gas.

Accidents, Occupational↗
PubMed1994

Occupational meanings and coping practices of rescue workers in an earthquake disaster.

On 17 October 1989, an earthquake measuring 7.1 on the Richter scale struck the San Francisco Bay Area, causing the collapse of .76 miles of a double-decker roadway (known as the Cypress Street Viaduct), resulting in the death of 42 people. A study examined the effects of rescue work at 6 and 20 months after the event, among 42 people including: military pararescuers, firefighters, transportation workers, and coroner-investigators. The researcher explored the rescuers' motivations, actions, coping strategies, interactions, and understanding of their responses to the event, as well as the practical wisdom each acquired. This article focuses on the 6-month data, and reports the specific work meanings and practices that shaped forms of involvement, issues of stress, and sources of coping that influenced the experience of rescue work in this disaster.

Adaptation, Psychological↗
PubMed2002

Influence of various factors on individual radiation exposure from the Chernobyl disaster.

BACKGROUND: The explosion at the Chernobyl Nuclear Power Plant was one of the greatest known nuclear disasters of the 20th century. To reduce individual exposure to ionizing radiation the Soviet Union government introduced a number of counter-measures. This article presents a description of how historical events conspired to disrupt these efforts and affect residents in exposed areas. METHODS: This study employed an extensive review of data on radionuclide deposition, contamination patterns and lifestyle characteristics. Data were obtained from the Ukraine Ministry of Health and the Ukraine Research Center for Radiation Medicine. RESULTS: Data are presented on annual contamination rates in selected locales as well as data on local food consumption patterns. Historical factors including economic and political circumstances are also highlighted. Results show the diminution of individual doses between 1987 and 1991 and then an increase between 1991 and 1994 and the relationship between this increase and changes in the lifestyle of the local population. CONCLUSION: A number of factors played direct and indirect roles in contributing to the populace's cumulative radiation exposure. Future post-contamination studies need to consider these factors when estimating individual exposures.

Disasters↗
PubMed2006

Disaster preparedness perspective from 90.05.32w, 29.57.18n.

A major disaster occurred in a major city in the USA. The aftermath produced significant difficulties in patient care. Failure of the communication system, lack of command and control, and incomplete planning were at the root of all of these difficulties.

Communication↗
PubMed2006

A single ventilator for multiple simulated patients to meet disaster surge.

OBJECTIVES: To determine if a ventilator available in an emergency department could quickly be modified to provide ventilation for four adults simultaneously. METHODS: Using lung simulators, readily available plastic tubing, and ventilators (840 Series Ventilator; Puritan-Bennett), human lung simulators were added in parallel until the ventilator was ventilating the equivalent of four adults. Data collected included peak pressure, positive end-expiratory pressure, total tidal volume, and total minute ventilation. Any obvious asymmetry in the delivery of gas to the lung simulators was also documented. The ventilator was run for almost 12 consecutive hours (5.5 hours of pressure control and more than six hours of volume control). RESULTS: Using readily available plastic tubing set up to minimize dead space volume, the four lung simulators were easily ventilated for 12 hours using one ventilator. In pressure control (set at 25 mm H2O), the mean tidal volume was 1,884 mL (approximately 471 mL/lung simulator) with an average minute ventilation of 30.2 L/min (or 7.5 L/min/lung simulator). In volume control (set at 2 L), the mean peak pressure was 28 cm H2O and the minute ventilation was 32.5 L/min total (8.1 L/min/lung simulator). CONCLUSIONS: A single ventilator may be quickly modified to ventilate four simulated adults for a limited time. The volumes delivered in this simulation should be able to sustain four 70-kg individuals. While further study is necessary, this pilot study suggests significant potential for the expanded use of a single ventilator during cases of disaster surge involving multiple casualties with respiratory failure.

Adult↗
PubMed2006

Population-based triage management in response to surge-capacity requirements during a large-scale bioevent disaster.

Both the naturally occurring and deliberate release of a biological agent in a population can bring catastrophic consequences. Although these bioevents have similarities with other disasters, there also are major differences, especially in the approach to triage management of surge capacity resources. Conventional mass-casualty events use uniform methods for triage on the basis of severity of presentation and do not consider exposure, duration, or infectiousness, thereby impeding control of transmission and delaying recognition of victims requiring immediate care. Bioevent triage management must be population based, with the goal of preventing secondary transmission, beginning at the point of contact, to control the epidemic outbreak. Whatever triage system is used, it must first recognize the requirements of those Susceptible but not exposed, those Exposed but not yet infectious, those Infectious, those Removed by death or recovery, and those protected by Vaccination or prophylactic medication (SEIRV methodology). Everyone in the population falls into one of these five categories. This article addresses a population approach to SEIRV-based triage in which decision making falls under a two-phase system with specific measures of effectiveness to increase likelihood of medical success, epidemic control, and conservation of scarce resources.

Bioterrorism↗
PubMed1979

Health consequences of the snow disaster in Massachusetts, February 6, 1978.

On February 6, 1978, the largest New England blizzard of the century struck eastern Massachusetts. On request, four days later, the Center for Disease Control provided epidemiologic assistance. On-site disaster assistance provided decision-makers with immediate health surveillance information useful in helping the area return to normal. No outbreaks of infectious diseases and no significant increase in the number of deaths were observed in the week following the blizzard. Some of the deaths which occurred immediately after the blizzard might have been prevented if traffic had been banned earlier.

Centers for Disease Control and Prevention, U.S.↗
PubMed2003

Disasters and the public health safety net: Hurricane Floyd hits the North Carolina Medicaid program.

OBJECTIVES: We measured the effect of Hurricane Floyd on Medicaid enrollment and health services use in the most severely affected counties of North Carolina. METHODS: We used differences-in-differences models on balanced panels of Medicaid claims and enrollment data. RESULTS: Overall spending per enrollee showed little short-term effect but demonstrated a moderate increase 1 year after the storm. We found very modest short-term increases in Medicaid enrollment, a small long-term decrease in enrollment, and large increases in the long-term use of emergency room and outpatient services. CONCLUSIONS: Our findings suggest that hurricane victims experienced substantial changes in patterns of care that endured for much longer than the initial crisis period. These findings can have important implications for the management of disaster relief for this population.

Ambulatory Care↗
PubMedDate not supplied

The effect of disaster on the health and well-being of older women.

Relatively little attention has been paid to the post-disaster health status and well-being of older persons. The data discussed in this article were gathered through use of a retrospective cohort survey five years following a major flood in the Wyoming Valley of Pennsylvania. The subsample of women sixty-five years and older used in this analysis is composed of 122 female victims and forty-five controls from the same communities. The instruments used to measure mental status included Langner's 22-Item Scale, Zung's Self-rating Depression Scale, and a modified Self-Report Symptom Inventory (SCL-90). Additional items related to self-perceptions of health status, to influence of the flood on health and well-being, and to other issues. Significant differences occurred in self-perceptions, including state of mind after the flood (p less than .001), distress during recovery (p less than .001), quality of life after the flood (p less than .001), and frequency of thinking about the flood matters (p less than .025). Use of the instruments designed to assess mental status did not indicate greater levels of anxiety or depression in elderly victims as compared to non-victims.

Adaptation, Psychological↗
PubMed2001

Epidemiologic features of pet evacuation failure in a rapid-onset disaster.

OBJECTIVE: To describe epidemiologic features of pet evacuation failure after a hazardous chemical spill in which residents had no warning and only a few hours notice to evacuate. DESIGN: Cross-sectional study. SAMPLE POPULATION: Pet-owning households that evacuated from a hazardous chemical spill with (n = 119) or without (122) their pets. Procedures-Evacuees were surveyed by mail. RESULTS: 261 of 433 (60.3%) dogs and cats in 241 households were not evacuated. Of the 241 households, 119 (49.4%) evacuated with their pets, 98 (40.7%) evacuated without them but later attempted to rescue them, and 24 (10.0%) neither evacuated their pets nor attempted to rescue them. Pet evacuation failure was most common in households that thought the evacuated area was safe for pets. Risk of pet evacuation failure increased in households with many animals, low pet attachment and commitment scores, and low levels of preparedness. Cat evacuation failure was associated with not having cat carriers. Nearly 80% of households that evacuated with their pets found accommodation with friends and family. CONCLUSIONS AND CLINICAL RELEVANCE: Pet evacuation failure was common and jeopardized pets' health and well-being. Logistical challenges to transporting pets were substantial contributors to pet evacuation failure, whereas not knowing where to house a pet was only a minor concern. Most pet owners seemed self-reliant and acted appropriately towards their pets. Such self-reliant behavior by pet owners should be encouraged prior to disasters as part of an evacuation plan for households.

Animals↗
PubMed1994

Perception of potential nuclear disaster: the relation of likelihood and consequence estimates of risk.

This study examined the correlations of ratings of expectation of a future disaster in a nuclear power plant and estimation of its consequences in a random sample of 150 adults who lived within two kilometers of a nuclear power plant. Analysis suggested a significant positive but low relation. This finding indicates that risk perception might be explored using constellations of beliefs and attitudes toward hazards without invoking personality characteristics like trait anxiety or demographic variables such as gender.

Anxiety↗
PubMed1984

The experience of a mental health team involved in the early phase of a disaster.

The reactions of a volunteer mental health team which convened in the aftermath of the 1983 Ash Wednesday bushfires are reported. A questionnaire designed to explore psychological and physical responses was completed by the 19 staff who made up the team. Using both open-ended and closed questions, the questionnaire tapped such areas as motivation, goals, expectations and observations, initial and later emotional and physical reactions, fantasies and evoked memories; an evaluation of the service and the experience was also included. Analysis of responses indicated that team members experienced considerable stress during their post-disaster work but also gained a great deal at both professional and personal levels. Sources of stress are discussed as are recommendations for their alleviation.

Adaptation, Psychological↗
PubMedDate not supplied

Group protocol to mitigate disaster stress and enhance social support in adolescents exposed to Hurricane Hugo.

Literature reports that cognitive understanding and social support can mitigate stress in both adults and adolescents. As a subcomponent of the Carolina Adolescent Health Project (CAHP), this research evaluated the efficacy of a Cognitive Social Support (CSS) group protocol designed to mitigate the disaster stress of adolescents who had been exposed seriously to Hurricane Hugo. A purposive sample of 259 students participated in and evaluated the CSS. This article reports the specific structure, content, process, rationale, and cost of the CSS. Evaluations indicated that 82% of the students evaluated the small-group component of the CSS as "very good" or "excellent," while 70% rated the large-group component as "very good" or "excellent."

Adolescent↗
PubMed2004

Almonte's great train disaster: Shaping nurses' roles and the civilian use of blood transfusion.

Blood transfusion was initially a small-scale, labour-intensive therapy administered by physicians. Through the first decades of the 20th century, transfusion comprised a "last resort" measure used and tested primarily in the context of war. Media accounts of the Almonte train disaster on the night of 27 December 1942 linked survival to the newly established blood bank located 42 km east in Ottawa, Ontario. This event did not constitute a "first time" occurrence or a "great discovery" in the history of blood. But it did illustrate in a very visible and public manner that blood transfusion technology was now readily available for use in general hospitals and civilian populations. Canada had an infrastructure for the collection, processing, storage, and transportation of blood products, and for the recruitment of blood donors by the mid-1940s. As the need for blood declined toward the end of World War II, transfusion became a technology in need of application. The extension of transfusion to civilian populations, however, would require a ready source of labour-increased numbers of health care workers who were available continuously with the necessary knowledge and skills to assume the responsibility. Nurses were well situated for this technological role by a convergence of scientific, economic, labour, gender, professional, and educational influences that both facilitated and constrained blood transfusion as a nursing competency. This paper examines how the expanded use of one medical technology shaped related roles for nurses. Transfusion ultimately influenced nurses' work and the composition of the workforce as the first medical act "delegated" to nurses in Ontario (1947), setting a precedent for the delegation of further technologies over the next four decades.

Blood Transfusion↗
PubMed2006

Post-traumatic stress disorder symptoms of children following the occurrence of Tehran City Park disaster.

The authors investigated the post-traumatic stress disorder (PTSD) symptoms of young adolescents who had been directly involved in a disaster in Tehran. The participants were 19 chlidren who had survived a boat sinking in Tehran's city park in 2002. By using the Post-Traumatic Stress Disorder Symptom Scale (PSS; E. B. Foa, D. S. Riggs, C. V. Dancu, & B. O. Rothbaum, 1993) as well as a clinical interview based on the definition cited in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994, p. 424), 16 participants (84.2%) were diagnosed with PTSD using the PSS and 17 (89.5%) were diagnosed with PTSD using the psychiatric interview.

Adolescent↗